Nebulised Colomycin

Why have I been prescribed nebulised colomycin?

The sputum of people with bronchiectasis can become infected with a bacteria called Pseudomonas aeruginosa. Colomycin (also known as colistimethate sodium) is an antibiotic used to treat Pseudomonas. It belongs to a group of antibiotics called polymyxin B. It can be given by intravenous injection (into a vein) or inhaled into the lungs through a nebuliser.

Nebulised colomycin can be used to treat a current chest infection or to reduce the number of chest infections happening in the future. The treatment is usually started by a chest consultant at the hospital. You can get a prescription for more colomycin from your family doctor (GP).

You will receive a trial dose in the hospital and will be shown how to set up the nebuliser machine and prepare the drug.

Why is colomycin given through a nebuliser?

A nebuliser allows colomycin to be inhaled directly into the airways. The risk of side-effects is small since only small amounts reach the bloodstream.

Before you use colomycin please read the patient information leaflet which comes with your medication.

This medication has been prescribed only for you. It is dangerous to pass it on to others as it may harm them.

Do not use colomycin if:

• you are allergic to colomycin (colistimethate sodium), colistin or another antibiotic called polymyxin B.
• you suffer from myasthenia gravis (a condition which causes muscle weakness and excessive tiredness).

Talk to your doctor if you have porphyria (a rare inherited condition) or kidney problems. Tell your doctor if you are taking other medicines.

• Coughing and bronchospasm (a tight feeling in the chest, increased shortness of breath, wheeze).
• A sore throat and mouth.
• Thrush infections (candida) of the mouth or throat.

Should you experience any of these symptoms stop the medication and inform us on: 0151 706 3310 (Royal Liverpool University Hospital/Broadgreen sites) or 0151 529 2483 (Aintree University hospital Site)

If you experience any difficulty in breathing, you should seek urgent medical attention and use a salbutamol inhaler – if you have this prescribed.

How should I store colomycin?

• Keep your colomycin out of the reach and sight of children.
• Do not store colomycin above 25°C.

How often will I take my treatment?

• Colomycin takes 10-15 minutes to nebulise, plus preparation time (depending on the dose this will either be twice a day (every 12 hours) or once a day).
• If you forget to take your nebulised colomycin do not worry, just take your next dose as scheduled.

How should I take nebulised colomycin?

• Before taking colomycin you may need to take reliever medication (salbutamol or terbutaline) to open the airways or to help prevent your chest getting tight.
• If you have any other nebuliser treatment such as salbutamol or ipratropium, this should be taken first and not with colomycin. These should be used with a different nebuliser giving set/kit.
• Do breathing exercises to clear the sputum from your lungs before taking colomycin. This will give you the best result from treatment.
• If you have been shown how to do postural drainage positioning and chest clearance (Active Cycle of Breathing) by a physiotherapist, you should do this after taking Salbutamol but before you take the colomycin.
• Colomycin should be nebulised in a well-ventilated room, ideally without any other people, animals or pets present.
• If you are also on hypertonic sodium chloride 6% or 7% nebules. This should be given

after the colomycin (using separate giving set/kit).

How do I prepare my medication?

Wash and dry your hands. Make sure you have all the following items:

• Nebuliser compressor - this is the electric machine that drives the nebuliser with air.
• AeroEclipse XL mouthpiece, chamber and tubing – This is the giving set/ kit which you inhale the medication through.
• Sodium chloride (0.9%) 2.5 mL nebules - You will need 2.5 mL for each million unit of colomycin.
• Colomycin (also called colistimethate sodium) is available in one- or two-million-unit bottles.
• Reliever medication - If you have a reliever inhaler or nebuliser (salbutamol or terbutaline) make sure you have it nearby in case your chest gets tight/ bronchospasms.

How do I mix my colomycin?

• Wash and dry your hands.
• Gently tap the bottle of colomycin to loosen the powder inside.
• Open the bottle of colomycin. Lift the plastic lid and tear off the foil seal around the rubber stopper. Take care as the foil may be sharp.
• Wash and dry your hands.
• Gently tap the bottle of colomycin to loosen the powder inside.
• Open the bottle of colomycin. Lift the plastic lid and tear off the foil seal around the rubber stopper. Take care as the foil may be sharp. 

• Remove the rubber stopper and keep it safely to one side.
• Twist open the nebule of sodium chloride 0.9%.

1. Squeeze the sodium chloride 0.9% nebule(s) into the bottle of colomycin and replace the rubber stopper.
2. Gently swirl/roll to mix the contents of the bottle. Do not shake as this will cause the colomycin to froth.

3. When all the powder has dissolved pour the liquid colomycin into the ‘AeroEclipse XL ban’ nebuliser chamber.

4.To do this, unscrew the chamber of the AeroEclipse XL from the top.

5.Carefully screw the ‘Aeroeclipse XL’ back together again making sure you do not spill

any liquid and keep upright.

6.Use the colomycin solution straight away. Safely dispose of any unused colomycin liquid immediately. Colomycin must not be mixed with other nebuliser medication.

7. Ensure the dial on top of the Aeroeclipse XL chamber is set to breath activated only (triangle with dots).

How do I take my colomycin?

• • Sit upright and put the mouthpiece gently between your teeth.
  • Switch on the nebuliser machine and breathe normally through your mouth.
  • Keep the AeroEclipse Nebuliser chamber upright to stop the liquid running into your mouth.
  • Don’t talk while you are taking the treatment to avoid wasting the medicine.
  • Colomycin has a strong taste and makes your mouth water so have tissues nearby. Swill your mouth out with water during and after use (as required).

Cleaning the equipment

1. The nebuliser kit/giving set should be cleaned after every use as per manufacturer’s

instructions.

2.Remove the tubing from the bottom of the nebuliser chamber.

3.Unscrew the nebuliser top.

4.Soak the mouthpiece, chamber and top of the nebuliser kit in a mild solution of liquid dish detergent and lukewarm clean water for about five minutes.

5.Rinse thoroughly with clean water, shake out excess water and allow to air dry before reassembling.

6.Alternatively, the two parts can be placed on the top rack of the dishwasher. Run the dishwasher on a normal cycle, do not heat dry.

7.Shake out excess water and allow to air dry before reassembling. Do not wash on a cycle with overly dirty dishes.

8.Store the nebuliser kit/giving set in a clean plastic bag or container.

• • When the colomycin powder is mixed with the sodium chloride 0.9% it is normal for the mixture to look hazy/white.
  • Colomycin should ideally be used immediately after preparation, if this is not possible it may be stored in a refrigerator for no longer than 24 hours.
  • Colomycin should not be mixed with other nebulised medicine, and a separate administration set should be used for colomycin only.
  • Using the nebuliser compressor filter as directed can reduce the amount of the drug passing into the surrounding air.
  • Your doctor/consultant will advise how long your treatment should last.
  • Do not use colomycin after the expiry date.
  • The colomycin medication will continue to be provided by your GP as part of your regular medication.

Nebuliser equipment

• • You will either be provided with a loan nebuliser machine from our team, or from community stores – this will be discussed at your appointment. For some patients, this will need to be organised by their GP or community team.
  • The nebuliser chamber and tubing (AeroEclipse XL) should be replaced every six months. Please contact the team who gave this to you (either the CNS team or community stores) to provide you with additional consumables when needed
  • The filters for the air compressor machine should be changed intermittently. Frequency of change will depend on the nebuliser machine, and you should be advised of this by the provider/ manufacturer’s guidance.
  • Your nebuliser machine should be serviced every 12 months, or if any concerns with the function of the machine please contact the team who provided the nebuliser compressor.
  • If there are any issues with your equipment, please contact the team who gave this to you (either the CNS team or community stores).

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